PROJECT SUMMARY Three vaccines introduced between 2005 and 2007, meningococcal conjugate vaccine (MenACWY); tetanus, diphtheria, and acellular pertussis vaccine (Tdap); and human papillomavirus (HPV) vaccine, are currently recommended for all adolescents aged 11-12 years. National data indicate important differences in HPV and MenACWY vaccine coverage between adolescents living in rural areas and urban central cities with no disparities in coverage for Tdap. Reasons for this geographic disparity are not clear. Better understanding of the factors contributing to the observed differences in rural and urban areas will inform strategies to address the rural-urban disparity in vaccine coverage by increasing vaccine uptake among adolescents living in rural areas. The aims of this project are 1) identify factors contributing to disparities in recommended vaccine coverage between adolescents living in rural areas and those living in urban areas, 2) develop and implement an intervention to improve vaccination coverage among adolescents living in rural area, and 3) evaluate the intervention effectiveness and identify strategies that may be effective in improving vaccination coverage among adolescents living in rural areas. We will administer surveys to parents and guardians of adolescents and primary care providers serving adolescents who live in rural and urban areas of Minnesota and Wisconsin in Year 1. The surveys will be designed to identify provider and parental factors associated with the rural-urban disparities. Survey results and qualitative in- depth interviews with providers and clinical staff will inform the intervention that will take place in Years 2 and 3. The intervention to increase rural adolescent vaccine uptake will be implemented and evaluated in a health system that serves a largely rural population. Evaluation of the intervention may consist of assessing changes in adolescent vaccination coverage, pre- and post- surveys of providers and parents of adolescents to assess changes in knowledge, attitudes, beliefs, vaccine counseling, and participation in intervention activities. Findings regarding potentially modifiable factors will inform strategies/interventions increase routine vaccination coverage of HPV and MenACWY among adolescents living in rural areas of the country, reducing the disparity between rural and urban areas.